Numbers provided by the Indiana Department of Health show how serious the problem is here.
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Free needles are available from the Needle Exchange Program the Scott County Health Department runs in Austin, Ind., in response to an HIV outbreak linked to intravenous drug use.(Photo: Kelly Wilkinson / IndyStar)Buy Photo

If reversing the opioid epidemic were easy, at least one state would have done it by now.

But in Indiana — and across the country — the death toll and collateral damage continue to rise.

Now, at least, the state has a plan to combat the opiate scourge that killed 619 Hoosiers in 2016, up from 262 in 2008. On average, the state’s emergency rooms handle more than 400 overdose visits a week, according to statistics from the Indiana State Department of Health.

Thursday, the Indiana Commission to Combat Drug Abuse unanimously approved a multipronged strategic action plan to address the opioid epidemic here. But the six-page plan and 13-page supporting document did not unveil one grand solution or new pot of money to fund the effort.

“The plan is a guide,” said Jim McClelland, the state’s drug czar, after the meeting. “What we’re trying to do is make sure we have all of the state’s resources aligned well, that they’re coordinated and focused and we’re trying to identify how we can best utilize the resources the state has.”

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McClelland said he plans to focus on two areas: Ensuring people who overdose have access to naloxone, a drug that can revive them, and creating more options for effective addiction treatment.

A $10.9 million federal 21st Century Cures Act grant awarded to the state late last month will at least in part address the latter goal. About $7.6 million of the grant, which comes from a pot of grant money for states made available under the Obama Administration, will help create 65 to 75 additional treatment beds statewide for those who cannot pay for their care.

Another $600,000 of the grant will hire peer recovery coaches who will work in hospitals in six to eight hard-hit areas of the state to encourage people who have just overdosed to consider treatment, Moore said. Eskenazi Health has a pilot project underway to explore the efficacy of such a program.

The program also will support mobile addiction teams and telehealth services to provide additional treatment options.

Treatment options have to extend beyond inpatient beds as neither the state nor the country will ever be able to create a sufficient number of residential treatment spots to serve everyone in need, said Dr. Jerome Adams, state health commissioner and a member of the commission.

“This commission and everyone here needs to rethink the way we provide treatment,” he said. “We need to know what best practices are. We can’t provide inpatient beds for everyone who has substance use disorder. What we can do is provide an evidence-based program that allows everyone to recover.”

Since an estimated 81,000 Healthy Indiana Plan recipients have a substance use disorder, the Family and Social Services Administration, which oversees the Medicaid program, included treatment for this population in its recent waiver application to the federal government. If approved, the waiver could provide up to $60 million to cover addiction services.

Currently only 28 percent of HIP recipients who have a formal diagnosis of substance use disorder receive care for it, according to the waiver. The waiver proposes adding “addiction recovery management services” as Medicaid covered benefits to allow for covering services such as relapse prevention, recovery education, housing support and more through community health workers.

With health care policy in Washington, D.C., in flux, however, it’s possible that this plan may not come through and FSSA officials concede that could prove a barrier.

“I can’t lie. It could be challenging, depending what comes out of the federal government to continue that funding source,” said Dr. Jennifer Walthall, FSSA secretary, “but we have plans A to Z ready to go to make sure that health care access is sustained for Hoosiers.”

On the whole, the plan is just what many advocacy groups, including his own, have been calling for, said Steven McCaffrey, president and chief executive officer of Mental Health America of Indiana. The FSSA waiver proposal would create ongoing funding for addiction services on a continuum of care from outpatient counseling to medication assisted treatment to inpatient services.

McCaffrey said that he saw the plan as a starting, not ending, point.

“We just now are beginning to see that addiction is a disease. That hasn’t always been the case,” he said. “It’s a great plan. When you have a plan like that, it can’t have all the details. … People are in a smart way trying to figure out the best use of funds to maximize their effect regardless of the financial silo that they come from. That’s exactly what we should be doing.”

FSSA is also working to ensure the state has a steady supply of affordable naloxone, working with the Indiana Department of Administration on a state contract that would allow any public entity to purchase the drug for a set, reasonable price, Walthall said.

As the use of naloxone has increased across the nation, the price has shot from about $31 a dose to about $84 a dose, said Douglas Carter, superintendent of the Indiana State Police. As more synthetic opioids and heroin laced with such drugs have hit the streets, responders often must use multiple doses to revive someone who has overdoses.

Some have criticized the plan for spending too much time on opiates, McClelland said, adding that was no accident. While the commission will not ignore other drugs, opiates will remain its focus.

“The emphasis on opioids is deliberate. That’s the crisis we’re currently facing,” he said. “Today we must have a strong sense of urgency to do what we can to help keep people alive.”

The Scott County Health Department Needle Exchange Program was started in 2015 as a response to an HIV outbreak linked to intravenous drug use in Scott County. Austin, IN is the epicenter of the crisis.
Kelly Wilkinson/IndyStar